Liver Transplantation of HCV-viremic Donors Into HCV-negative Recipients in the United States: Increasing Frequency With Profound Geographic Variation

Transplantation. 2021 Jun 1;105(6):1285-1290. doi: 10.1097/TP.0000000000003382.


Background: Direct-acting antiviral therapy made possible the novel practice of utilizing hepatitis C virus (HCV)-viremic (HCV RNA-positive) donors into HCV-negative recipients in the United States. Although initial reports of outcomes have been satisfactory, higher-quality longer-term outcomes remain to be elucidated.

Methods: National data were examined from the Organ Procurement and Transplantation Network on adult patients in the United States who underwent a primary, single organ, deceased donor liver transplant from January 1, 2016 to March 31, 2020. Outcomes of HCV-negative recipients (R-) who received an allograft from donors who were HCV RNA-positive (D HCV+) donors were compared with HCV RNA-negative (D HCV-) donors.

Results: There has been a 35-fold increase in D HCV+/R- liver transplants over the past 4 y in the United States, from 8 in 2016 to 280 in 2019. There was an almost 6-fold difference in this practice among UNOS geographic regions. Graft survival following D HCV+/R- liver transplantation was excellent, with 1-y rates being 91% and 90% and 2-y rates being 88.5% and 87% for D HCV+/R- and D HCV-/R-, respectively (P = 0.672). In multivariate analysis, adjusting for other donor and recipient attributes, D HCV+/R- was not associated with patient or graft survival.

Conclusions: The practice of D HCV+/R- continues to increase without discernible impact on medium-term outcomes. Notable geographic variation exists, suggesting inconsistent perceptions about the impact of D HCV+/R- transplantation on outcomes. These results strengthen the perceived safety in utilizing HCV-viremic donor organs as a donor pool expansion strategy, not only in the United States, but also worldwide.

MeSH terms

  • Adult
  • Antiviral Agents / adverse effects
  • Antiviral Agents / therapeutic use*
  • Databases, Factual
  • Donor Selection*
  • Female
  • Graft Survival
  • Healthcare Disparities / trends*
  • Hepatitis C / diagnosis
  • Hepatitis C / drug therapy*
  • Hepatitis C / epidemiology
  • Humans
  • Liver Transplantation / adverse effects
  • Liver Transplantation / trends*
  • Male
  • Middle Aged
  • Practice Patterns, Physicians' / trends*
  • RNA, Viral / genetics
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Tissue Donors / supply & distribution*
  • Treatment Outcome
  • United States / epidemiology
  • Viral Load
  • Viremia / diagnosis
  • Viremia / drug therapy*
  • Viremia / epidemiology


  • Antiviral Agents
  • RNA, Viral